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Montoya-Williams D, Barreto A, Laguna-Torres A, Worsley D, Wallis K, Peña MM, Palladino L, Salva N, Levine L, Rivera A, Hernandez R, Fuentes-Afflick E, Yun K, Lorch S, Virudachalam S. Philadelphia Latine Immigrant Birthing People's Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization. Med Care 2024; 62:404-415. [PMID: 38728679 PMCID: PMC11090453 DOI: 10.1097/mlr.0000000000002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
RESEARCH DESIGN Community-engaged qualitative study using inductive thematic analysis of semistructured interviews. OBJECTIVE To understand Latine immigrants' recent prenatal care experiences and develop community-informed strategies to mitigate policy-related chilling effects on prenatal care utilization. BACKGROUND Decreased health care utilization among immigrants due to punitive immigration policies (ie, the "chilling effect") has been well-documented among Latine birthing people both pre and postnatally. PATIENTS AND METHODS Currently or recently pregnant immigrant Latine people in greater Philadelphia were recruited from an obstetric clinic, 2 pediatric primary care clinics, and 2 community-based organization client pools. Thematic saturation was achieved with 24 people. Participants' pregnancy narratives and their perspectives on how health care providers and systems could make prenatal care feel safer and more comfortable for immigrants. RESULTS Participants' recommendations for mitigating the chilling effect during the prenatal period included training prenatal health care providers to sensitively initiate discussions about immigrants' rights and reaffirm confidentiality around immigration status. Participants suggested that health care systems should expand sources of information for pregnant immigrants, either by partnering with community organizations to disseminate information or by increasing access to trusted individuals knowledgeable about immigrants' rights to health care. Participants also suggested training non-medical office staff in the use of interpreters. CONCLUSION Immigrant Latine pregnant and birthing people in greater Philadelphia described ongoing fear and confusion regarding the utilization of prenatal care, as well as experiences of discrimination. Participants' suggestions for mitigating immigration-related chilling effects can be translated into potential policy and programmatic interventions which could be implemented locally and evaluated for broader applicability.
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Affiliation(s)
- Diana Montoya-Williams
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Alejandra Barreto
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alicia Laguna-Torres
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diana Worsley
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kate Wallis
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michelle-Marie Peña
- Department of Pediatrics, Division of Neonatology, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Lauren Palladino
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nicole Salva
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA
| | - Lisa Levine
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Obstetrics and Gynecology, Penn Medicine, Philadelphia, PA, USA
| | | | | | - Elena Fuentes-Afflick
- Division of General Pediatrics University of California, San Francisco, San Francisco, CA
| | - Katherine Yun
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Lorch
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- CHOP PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Senbagam Virudachalam
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Santaularia NJ, Hunt SL, Bonilla Z. Exploring the Links Between Immigration and Birth Outcomes Among Latine Birthing Persons in the USA. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01999-x. [PMID: 38713369 DOI: 10.1007/s40615-024-01999-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Birth outcomes are worse for birthing people and infants in the USA than other high-income economies and worse still for underprivileged communities. Historically, the Latine community has experienced positive birth outcomes, despite low socioeconomic status and other socio-political disadvantages, leading to what has been termed as the Hispanic birth paradox. However, this perinatal advantage and protective effect appears to have been shattered by unfavorable policies, structural conditions, societal attitudes, and traumatic events impacting Latine immigrants, leading to negative effects on the health and well-being of birthing Latines-regardless of citizenship status and increasing rates of preterm birth and low birth weight infants. METHODS AND RESULTS We conducted a comprehensive literature review and identified two pathways through which birth outcomes among Latine birthing persons may be compromised regardless of citizenship status: (1) a biological pathway as toxic levels of fear and anxiety created by racialized stressors accumulate in the bodies of Latines and (2) a social pathway as Latines disconnect from formal and informal sources of support including family, friends, health care, public health programs, and social services during the course of the pregnancy. CONCLUSION Future research needs to examine the impact of immigration climate and policies on health and racial equity in birth outcomes among Latines regardless of citizenship status. Attaining health and racial equity necessitates increased awareness among health providers, public health practitioners, and policy makers of the impact of larger socio-political pressures on the health of Latine birthing persons.
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Affiliation(s)
- N Jeanie Santaularia
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Shanda Lee Hunt
- University Libraries, University of Minnesota, Minneapolis, MN, USA
| | - Zobeida Bonilla
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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3
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Galletly CL, McAuliffe TL, Dickson-Gomez JB, Glasman LR, Ruelas DM. The Relative Influence of Perceived Immigration Laws and Consequences on HIV Testing Among US Latino Immigrants. AIDS Behav 2024; 28:1301-1313. [PMID: 37632603 DOI: 10.1007/s10461-023-04159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
The CDC recommends that persons aged 13-64 receive an HIV test at least once in their lifetime and that some groups test annually or more frequently. Nearly one-half of US Latino immigrants have never been tested for HIV. To the extent that immigration-related laws deter documented and undocumented immigrants from engaging in communicable disease control measures, these laws undermine public health efforts. 1750 noncitizen adult, sexually active, Spanish-speaking Latino immigrants across four cities in the US completed a cross-sectional survey assessing perceptions of immigration-related laws and immigration consequences related to HIV testing and diagnosis. Participants were recruited in-person by staff in community settings, through flyers posted in places frequented by Latino immigrants, and by word-of-mouth through snowball sampling. Outcomes were whether participants had ever received an HIV test and whether they tested in the previous 12 months. Multivariable analyses examined the relative contribution of perceived immigration laws and consequences on HIV testing behaviors when considering established predictors of HIV testing. Perceptions of HIV-related immigration laws and immigration consequences was a significant predictor of never having had an HIV test even when considered relative to common predictors of HIV testing. The influence of perceived immigration laws and consequences on testing in the previous 12 months was not significant in multivariable analysis. Perceived HIV-related immigration laws and consequences appear to be a substantial contributor to reluctance to be tested for HIV among Latino immigrants who have never been tested. Effective interventions should be developed to address these.
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Affiliation(s)
- Carol L Galletly
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 1710 East Lafayette Place, Milwaukee, WI, 53202, USA.
| | - Timothy L McAuliffe
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 1710 East Lafayette Place, Milwaukee, WI, 53202, USA
| | - Julia B Dickson-Gomez
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 1710 East Lafayette Place, Milwaukee, WI, 53202, USA
- Institute for Health Equity, Medical College of Wisconsin, Milwaukee, USA
| | - Laura R Glasman
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 1710 East Lafayette Place, Milwaukee, WI, 53202, USA
| | - Dulce M Ruelas
- College of Nursing & Healthcare Professions, Grand Canyon University, Phoenix, USA
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4
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Mercado O, Nelin TD, Arias-Oliveras A, Montoya-Williams D. Inequities Faced by Children in Immigrant Families in United States NICUs. Neoreviews 2024; 25:e237-e244. [PMID: 38556495 DOI: 10.1542/neo.25-4-e237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Osvaldo Mercado
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Timothy D Nelin
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ana Arias-Oliveras
- Division of Pediatrics General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Diana Montoya-Williams
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
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5
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Mercado O, Nelin TD, Arias-Oliveras A, Montoya-Williams D. Inequities Faced by Children in Immigrant Families in United States NICUs. Neoreviews 2024; 25:e237-e244. [PMID: 38556487 DOI: 10.1542/neo.25-3-e237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Osvaldo Mercado
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Timothy D Nelin
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ana Arias-Oliveras
- Division of Pediatrics General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Diana Montoya-Williams
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA
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Jun H, Mattke S, Chen A, Aguila E. The Value of Medicare Coverage on Depressive Symptoms Among Older Immigrants. THE GERONTOLOGIST 2024; 64:gnad070. [PMID: 37330627 PMCID: PMC10825837 DOI: 10.1093/geront/gnad070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The immigrant population, the primary driver of U.S. population growth, is aging and many immigrants remain uninsured. Lack of health insurance limits access to care, aggravating the already high level of depression for older immigrants. However, there is scarce evidence on how health insurance, particularly Medicare, affects their mental health. Using the Health and Retirement Study, this study examines the effect of Medicare coverage on depressive symptoms of older immigrants in the United States. RESEARCH DESIGN AND METHODS Exploiting the fact that many immigrants are not covered by Medicare after passing age 65, we use a difference-in-difference model with propensity score weighting to compare differences in depressive symptoms pre- and post-age-65. We further stratify the sample by socioeconomic status and by race/ethnicity. RESULTS Medicare coverage was significantly associated with a reduction in the probability of reporting depressive symptoms for immigrants with low socioeconomic status, especially for those below median wealth levels. The beneficial effect of Medicare coverage was also statistically significant for non-White immigrants-Black, Hispanic, and Asian/Pacific Islander-even when holding socioeconomic status constant. DISCUSSION AND IMPLICATIONS Our findings imply that immigration policies that expand health care protection to older immigrants can lead to further health benefits and reduce existing disparities for the aging population. Policy reforms such as providing limited Medicare access to immigrants who paid sufficient taxes but are still awaiting permanent residency status could increase coverage for the uninsured and improve participation of immigrants in the payroll system.
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Affiliation(s)
- Hankyung Jun
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Soeren Mattke
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
| | - Alice Chen
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
| | - Emma Aguila
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA
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Lopez KN, Allen KY, Baker-Smith CM, Bravo-Jaimes K, Burns J, Cherestal B, Deen JF, Hills BK, Huang JH, Lizano Santamaria RW, Lodeiro CA, Melo V, Moreno JS, Nuñez Gallegos F, Onugha H, Pastor TA, Wallace MC, Ansah DA. Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States. J Cardiovasc Dev Dis 2024; 11:36. [PMID: 38392250 PMCID: PMC10888593 DOI: 10.3390/jcdd11020036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.
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Affiliation(s)
- Keila N Lopez
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kiona Y Allen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Carissa M Baker-Smith
- Center for Cardiovascular Research and Innovation, Nemours Cardiac Center, Nemours Children's Health, Wilmington, DE 19803, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA
| | - Joseph Burns
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Bianca Cherestal
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO 64108, USA
| | - Jason F Deen
- Department of Pediatrics and Medicine, University of Washington, Seattle, WA 98105, USA
| | - Brittany K Hills
- Division of Pediatric Cardiology, UT Southwestern, Children's Health, Dallas, TX 75390, USA
| | - Jennifer H Huang
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Carlos A Lodeiro
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Valentina Melo
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jasmine S Moreno
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Flora Nuñez Gallegos
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital, San Francisco, CA 94158, USA
| | - Harris Onugha
- Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Tony A Pastor
- Division of Pediatric Cardiology, Yale School of Medicine, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Michelle C Wallace
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Deidra A Ansah
- Texas Children's Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Houston, TX 77030, USA
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Chaparro MP, Auchincloss AH, Argibay S, Ruggiero DA, Purtle J, Langellier BA. County- and state-level immigration policies are associated with Supplemental Nutrition Assistance Program (SNAP) participation among Latino households. Soc Sci Med 2023; 333:116141. [PMID: 37572629 PMCID: PMC10530172 DOI: 10.1016/j.socscimed.2023.116141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
The purpose of this study was to investigate the association between county- and state-level immigrant criminalizing and integrating policies and Latino household participation in the largest safety net program against food insecurity in the U.S., the Supplemental Nutrition Assistance Program (SNAP). Our outcome, county-level proportion of SNAP-participating Latino households, and county-level covariates were obtained from the American Community Survey 1-year county files (N = 675 counties) for 13 years (2007-2019). Our exposures were county-level presence of sanctuary policies and a state-level immigrant friendliness score, created based on 19 immigrant criminalizing and integrating state-level policies obtained from the Urban Institute's State Immigration Policies Resource. We classified every county in the sample as 1) sanctuary policy + immigrant friendly state, 2) sanctuary policy + immigrant unfriendly state, 3) no sanctuary policy + immigrant friendly state, and 4) no sanctuary policy + immigrant unfriendly state. Using multivariable generalized linear models that adjusted for poverty levels and other social composition characteristics of counties, we found that county-level SNAP participation among Latino households was 1.1 percentage-point higher in counties with sanctuary policies (B = 1.12, 95%CI = 0.26-1.98), compared to counties with no sanctuary policies, and 1.6 percentage-point higher in counties with sanctuary policies in immigrant friendly states (B = 1.59, 95%CI = 0.33-2.84), compared to counties with no sanctuary policy in immigrant unfriendly states. Local and state immigration policy, even when unrelated to SNAP eligibility, may influence SNAP participation among Latino households. Jurisdictions which lack sanctuary policies or have more criminalizing and less integrating policies should consider adopting targeted outreach strategies to increase SNAP enrollment among Latino households.
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Affiliation(s)
- M Pia Chaparro
- Nutritional Sciences Program, Department of Health Systems and Population Health, School of Public Health, University of Washington, Raitt Hall 305, Box 353410, Seattle, WA, 98195, USA.
| | - Amy H Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Sofia Argibay
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Dominic A Ruggiero
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
| | - Jonathan Purtle
- Department of Public Health Policy and Management, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
| | - Brent A Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Nesbitt Hall, 3215 Market St., Philadelphia, PA, 19104, USA.
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Keeton VF, Bell JF, Drake C, Fernandez Y Garcia EO, Pantell M, Hessler D, Wing H, Silveira PP, O'Donnell KJ, de Mendonça Filho EJ, Meaney MJ, Gottlieb LM. Household Social Needs, Emotional Functioning, and Stress in Low-Income Latinx Children and their Mothers. JOURNAL OF CHILD AND FAMILY STUDIES 2023; 32:796-811. [PMID: 37143480 PMCID: PMC10156014 DOI: 10.1007/s10826-023-02532-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Latinx families may be particularly vulnerable to emotional dysfunction, due to higher rates of economic hardship and complex social influences in this population. Little is known about the impact of environmental stressors such as unmet social needs and maternal stress on the emotional health of Latinx children from low-income families. We conducted secondary analyses using survey and biomarker data from 432 Latinx children and mothers collected in a separate study. We used binomial and multinomial logistic regression to test if household social needs, or maternal perceived stress or hair cortisol concentration (HCC), predicted child measures of emotional functioning or child HCC, independent of relevant sociodemographic factors. Approximately 40% of children in the sample had symptoms consistent with emotional dysfunction, and over 37% of households reported five or more social needs. High perceived maternal stress predicted higher odds of child emotional dysfunction (OR = 2.15; 95% CI [1.14, 4.04]; p = 0.01), and high maternal HCC was positively associated with high child HCC (OR = 10.60; 95% CI [4.20, 26.74]; p < 0.01). Most individual household social needs, as well as the level of household social need, were not independently associated with child emotional dysfunction or child HCC. Our findings begin to define a framework for understanding emotional health, stress, and resilience when caring for Latinx children and mothers living with high levels of social need, and the need for integrated mental health and social needs screening and interventions in settings that serve this population.
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Affiliation(s)
- Victoria F Keeton
- Corresponding Author: V.F. Keeton, University of California, San Francisco, Department of Obstetrics, Gynecology, & Reproductive Sciences, Box 2930, San Francisco, CA, USA 94143
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48 St., Sacramento, CA, USA 95817
| | - Janice F Bell
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48 St., Sacramento, CA, USA 95817
| | - Christiana Drake
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48 St., Sacramento, CA, USA 95817
- University of California, Davis, Department of Statistics, 4101 Mathematical Sciences Bldg., Davis, CA, USA 95616
| | - Erik O Fernandez Y Garcia
- University of California, Davis, Betty Irene Moore School of Nursing, 2450 48 St., Sacramento, CA, USA 95817
- University of California, Davis, Department of Pediatrics, 2521 Stockton Blvd, Suite 2200, Sacramento, CA, USA 95817
| | - Matthew Pantell
- University of California, San Francisco, Department of Pediatrics, 3333 California Street, Box 0848, San Francisco, CA, USA 94143
| | - Danielle Hessler
- University of California, San Francisco, Department of Family and Community Medicine, 500 Parnassus Ave, Box 0900, San Francisco, CA, USA 94143
| | - Holly Wing
- University of California, San Francisco, Center for Health and Community, 3333 California St., Box 0844, San Francisco, CA, USA 94143
| | - Patricia P Silveira
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, 6875 Boulevard LaSalle Montreal, Québec, CA H4H1R3
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Kieran J O'Donnell
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, 6875 Boulevard LaSalle Montreal, Québec, CA H4H1R3
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, McGill University, Montreal, QC, Canada
- Yale Child Study Center & Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, 230 South Frontage Rd., New Haven, CT, USA 06519
| | - Euclides José de Mendonça Filho
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, 6875 Boulevard LaSalle Montreal, Québec, CA H4H1R3
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Michael J Meaney
- Douglas Mental Health University Institute, Douglas Research Center, McGill University, 6875 Boulevard LaSalle Montreal, Québec, CA H4H1R3
- Ludmer Centre for Neuroinformatics and Mental Health and Department of Psychiatry, McGill University, Montreal, QC, Canada
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), 1 Fusionopolis Way, #20-10, Singapore, Republic of Singapore 138632
| | - Laura M Gottlieb
- University of California, San Francisco, Department of Family and Community Medicine, 500 Parnassus Ave, Box 0900, San Francisco, CA, USA 94143
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10
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Bustamante AV. Post-COVID19 strategies to support the health care interactions of U.S. Mexican immigrants and return migrants with the Mexican health system. J Migr Health 2023; 7:100170. [PMID: 36938330 PMCID: PMC10015227 DOI: 10.1016/j.jmh.2023.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 03/07/2023] Open
Abstract
Background Mexican migrants in the United States (U.S.) are twice more likely to underutilize health care and to experience low quality of care compared to the U.S.-born population. Current and former Mexican migrants in the U.S have used health services in Mexico due to lower cost, perceived quality, cultural familiarity, and the geographic proximity of the two countries. Objective This study aims to characterize the different health care interactions of current and former U.S. Mexican migrants with public and private health care organizations of the Mexican health system and to identify strategies to improve health care interactions post-COVID19. Methods We use a typology of cross-border patient mobility to analyze the facilitators and barriers to improve the health care interactions of current and former U.S. Mexican migrants with the Mexican health system. Our policy analysis framework examines how an outcome can be achieved by various configurations or combinations of independent variables. The main outcome variable is the improvement of health care interactions of U.S. Mexican migrants and return migrants with different government agencies and public and private health care providers in the Mexican health system. The main explanatory variables are availability, affordability, familiarity, perceived quality of health care and type of health coverage. Findings As the Mexican health system emerges from the COVID19 pandemic, new strategies to integrate current and former U.S. Mexican migrants to the Mexican health system could be considered such as the expansion of telehealth services, a regulatory framework for health services used by transnational patients, making enrollment procedures more flexible for return migrants and guiding return migrants as they reintegrate to the Mexican health system. Conclusions The health care interactions of U.S. Mexican migrants with the Mexican health system are likely to increase in the upcoming decades due to population ageing. Regulatory improvements and programs that address the unique needs of U.S. Mexican migrants and return migrants could substantially improve their health care interactions with the Mexican health system.
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